{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T17:05:27Z","timestamp":1779210327927,"version":"3.51.4"},"reference-count":21,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T00:00:00Z","timestamp":1759795200000},"content-version":"vor","delay-in-days":29,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,9,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Unexpected horizontal tumour spread towards the proximal and distal margins complicates the assessment of surgical margins in oesophagogastric junction (OGJ) cancer. Its impact on oncological outcomes remains unclear.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This study retrospectively analysed patients with OGJ adenocarcinoma undergoing proximal or total gastrectomy. Unexpected horizontal tumour spread was measured as the discrepancy between gross and pathological margins proximally (\u0394PM) and distally (\u0394DM). Clinicopathological features, recurrence-free survival (RFS), and overall survival (OS) were evaluated based on \u0394PM and \u0394DM.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Based on cut-off values identified by time-dependent receiver operating characteristic curve analysis (\u0394PM, 8\u2005mm; \u0394DM, 3\u2005mm) in 197 patients, patients were classified into four groups: short; long \u0394PM; long \u0394DM; and both long \u0394PM and \u0394DM (both-long). RFS was best in the short group and worst in the both-long group. The long \u0394PM and long \u0394DM groups had intermediate and comparable RFS. Subsequently, patients were categorized into two groups: a short group and a long group, which included patients in the long \u0394PM, long \u0394DM, and both-long groups. The type of infiltrative growth and postoperative recurrence were significantly associated with the long group. Moreover, the long group had significantly worse RFS and OS than the short group. Multivariate Cox regression analyses identified the long group as an independent risk factor for both RFS and OS. Patients in the long group with clinical lymph node metastasis or tumours located in the proximal 2-cm segment of the OGJ, predominantly in the proximal rather than distal 2-cm segment of the OGJ, or equal involvement in both areas had markedly worse survival outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Unexpected horizontal tumour spread, represented by \u0394PM and \u0394DM, is a strong predictor of poor survival and recurrence in OGJ cancer. Intraoperative assessment of \u0394PM and \u0394DM using frozen section analysis may be useful in guiding additional resections, particularly when combined with other predictive factors.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/bjsopen\/zraf119","type":"journal-article","created":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T15:16:48Z","timestamp":1759850208000},"source":"Crossref","is-referenced-by-count":2,"title":["Oncological impact of unexpected horizontal tumour spread in oesophagogastric junction cancer"],"prefix":"10.1093","volume":"9","author":[{"given":"Qingjiang","family":"Hu","sequence":"first","affiliation":[{"name":"Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research , Tokyo ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7417-3682","authenticated-orcid":false,"given":"Manabu","family":"Ohashi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research , Tokyo ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Motonari","family":"Ri","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research , Tokyo ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rie","family":"Makuuchi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research , Tokyo ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomoyuki","family":"Irino","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research , Tokyo ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masaru","family":"Hayami","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research , Tokyo ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takeshi","family":"Sano","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research , Tokyo ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3012-5632","authenticated-orcid":false,"given":"Souya","family":"Nunobe","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research , Tokyo ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,10,7]]},"reference":[{"key":"2025100711111538900_zraf119-B1","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1002\/bjs.7310","article-title":"Changes in clinicopathological features and survival after gastrectomy for gastric cancer over a 20-year period","volume":"98","author":"Ahn","year":"2011","journal-title":"Br J Surg"},{"key":"2025100711111538900_zraf119-B2","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1007\/s10120-011-0085-6","article-title":"Gastric cancer treatment in Japan: 2008 annual report of the JGCA nationwide registry","volume":"14","author":"Isobe","year":"2011","journal-title":"Gastric Cancer"},{"key":"2025100711111538900_zraf119-B3","doi-asserted-by":"crossref","first-page":"1662","DOI":"10.1111\/j.1440-1746.2008.05572.x","article-title":"Changing trends in the proportion of adenocarcinoma of the esophagogastric junction in a large tertiary referral center in Japan","volume":"23","author":"Kusano","year":"2008","journal-title":"J Gastroenterol Hepatol"},{"key":"2025100711111538900_zraf119-B4","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1007\/s10120-011-0041-5","article-title":"Japanese classification of gastric carcinoma: 3rd English edition","volume":"14","author":"Japanese Gastric Cancer Association","year":"2011","journal-title":"Gastric Cancer"},{"key":"2025100711111538900_zraf119-B5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s10120-022-01331-8","article-title":"Japanese gastric cancer treatment guidelines 2021 (6th edition)","volume":"26","author":"Japanese Gastric Cancer Association","year":"2023","journal-title":"Gastric Cancer"},{"key":"2025100711111538900_zraf119-B6","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1093\/jjco\/hyac019","article-title":"Surgical and perioperative treatment strategy for resectable esophagogastric junction cancer","volume":"52","author":"Yanagimoto","year":"2022","journal-title":"Jpn J Clin Oncol"},{"key":"2025100711111538900_zraf119-B7","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1007\/s10120-015-0589-6","article-title":"Risk factor analysis for involvement of resection margins in gastric and esophagogastric junction cancer: an Italian multicenter study","volume":"20","author":"Bissolati","year":"2017","journal-title":"Gastric Cancer"},{"key":"2025100711111538900_zraf119-B8","doi-asserted-by":"crossref","first-page":"e026","DOI":"10.1097\/AS9.0000000000000026","article-title":"A \u2018just enough\u2019 gross proximal margin length ensuring pathologically complete resection in distal gastrectomy for gastric cancer","volume":"1","author":"Hayami","year":"2020","journal-title":"Ann Surg Open"},{"key":"2025100711111538900_zraf119-B9","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1007\/s10120-023-01369-2","article-title":"Required esophageal resection length beyond the tumor boundary to ensure a negative proximal margin for gastric cancer with gross esophageal invasion or esophagogastric junction cancer","volume":"26","author":"Koterazawa","year":"2023","journal-title":"Gastric Cancer"},{"key":"2025100711111538900_zraf119-B10","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1007\/s10120-022-01304-x","article-title":"Minimum resection length to ensure a pathologically negative distal margin and the preservation of a larger remnant stomach in proximal gastrectomy for early upper gastric cancer","volume":"25","author":"Koterazawa","year":"2022","journal-title":"Gastric Cancer"},{"key":"2025100711111538900_zraf119-B11","doi-asserted-by":"crossref","first-page":"e127","DOI":"10.1097\/AS9.0000000000000127","article-title":"Minimum esophageal resection length to ensure negative proximal margin in total gastrectomy for gastric cancer: a retrospective study","volume":"3","author":"Koterazawa","year":"2022","journal-title":"Ann Surg Open"},{"key":"2025100711111538900_zraf119-B12","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1007\/s10120-023-01401-5","article-title":"Oncological impact of unexpected horizontal tumor spread in gastric cancer that requires total gastrectomy","volume":"26","author":"Koterazawa","year":"2023","journal-title":"Gastric Cancer"},{"key":"2025100711111538900_zraf119-B13","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1007\/s10120-025-01581-2","article-title":"Minimum resection length to ensure a pathologically negative distal margin and a larger remnant stomach for esophagogastric junction cancer","volume":"28","author":"Hu","year":"2025","journal-title":"Gastric Cancer"},{"key":"2025100711111538900_zraf119-B14","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1097\/SLA.0000000000003499","article-title":"Mapping of lymph node metastasis from esophagogastric junction tumors: a prospective nationwide multicenter study","volume":"274","author":"Kurokawa","year":"2021","journal-title":"Ann Surg"},{"key":"2025100711111538900_zraf119-B15","doi-asserted-by":"crossref","first-page":"1810","DOI":"10.1056\/NEJMoa072252","article-title":"Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine","volume":"357","author":"Sakuramoto","year":"2007","journal-title":"N Engl J Med"},{"key":"2025100711111538900_zraf119-B16","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/S0140-6736(11)61873-4","article-title":"Adjuvant capecitabine and oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): a phase 3 open-label, randomised controlled trial","volume":"379","author":"Bang","year":"2012","journal-title":"Lancet"},{"key":"2025100711111538900_zraf119-B17","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1007\/s10120-015-0581-1","article-title":"Phase II study of adjuvant chemotherapy of S-1 plus oxaliplatin for patients with stage III gastric cancer after D2 gastrectomy","volume":"20","author":"Shitara","year":"2017","journal-title":"Gastric Cancer"},{"key":"2025100711111538900_zraf119-B18","doi-asserted-by":"crossref","first-page":"e036","DOI":"10.1097\/AS9.0000000000000036","article-title":"Oncological impact of gross proximal margin length in distal gastrectomy for gastric cancer: is the Japanese recommendation valid?","volume":"2","author":"Hayami","year":"2021","journal-title":"Ann Surg Open"},{"key":"2025100711111538900_zraf119-B19","doi-asserted-by":"crossref","first-page":"1600","DOI":"10.1093\/jnci\/djt270","article-title":"Disease-free survival as a surrogate for overall survival in adjuvant trials of gastric cancer: a meta-analysis","volume":"105","author":"Oba","year":"2013","journal-title":"J Natl Cancer Inst"},{"key":"2025100711111538900_zraf119-B20","doi-asserted-by":"crossref","first-page":"3267","DOI":"10.1158\/1078-0432.CCR-22-3626","article-title":"The emerging role of circulating tumor DNA in non-colorectal gastrointestinal cancers","volume":"29","author":"Lee","year":"2023","journal-title":"Clin Cancer Res"},{"key":"2025100711111538900_zraf119-B21","doi-asserted-by":"crossref","first-page":"3272","DOI":"10.1038\/s41591-024-03254-6","article-title":"ctDNA-based molecular residual disease and survival in resectable colorectal cancer","volume":"30","author":"Nakamura","year":"2024","journal-title":"Nat Med"}],"container-title":["BJS Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/bjsopen\/article-pdf\/9\/5\/zraf119\/64537515\/zraf119.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/bjsopen\/article-pdf\/9\/5\/zraf119\/64537515\/zraf119.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T15:17:15Z","timestamp":1759850235000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/bjsopen\/article\/doi\/10.1093\/bjsopen\/zraf119\/8276831"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,8]]},"references-count":21,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,9,8]]}},"URL":"https:\/\/doi.org\/10.1093\/bjsopen\/zraf119","relation":{},"ISSN":["2474-9842"],"issn-type":[{"value":"2474-9842","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,10]]},"published":{"date-parts":[[2025,9,8]]},"article-number":"zraf119"}}